Long-Term Results of Liver Transplantation in Patients 60 Years of Age and Older

Collins, Bradley H.; Pirsch, John D.; Becker, Yolanda T.; Hanaway, Michael J.; Werf, Willem J. Van der; D’Alessandro, Anthony M.; Knechtle, Stuart J.; Odorico, Jon S.; Leverson, Glen; Musat, Alexandru I.; Armbrust, Michael; Becker, Bryan N.; Sollinger, Hans W.; Kalayoğlu, Münci

doi:10.1097/00007890-199810270-00166

Cited by 57 publications

(78 citation statements)

References 12 publications

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“…Other groups have also reported worse outcomes in older populations. 16,17 In this series, we demonstrated no significant difference in survival between groups within the first 5 yr after LT, suggesting that age in isolation should not be a contraindication to transplantation, a finding consistent with data from other groups. [18][19][20][21][22] However, it is evident that after 5 yr, survival of patients aged 65 yr and older begins to diminish.…”

Section: Discussionsupporting

confidence: 88%

“…The improvements in outcomes observed between our study and earlier stud- [15][16][17] may be due to several reasons, including advances in surgical technique, improved intensive care, and standardized immunosuppressive therapy. Indeed, the majority of transplants (71/77, 93%) in patients aged Ͼ65 yr were performed after 1994, in contrast to the other studies.…”

Section: Discussionsupporting

confidence: 51%

“…14 Therefore, in the context of transplantation, although immunosenescence may be beneficial in reducing the number of episodes of ACR and enhancing graft survival, this may be at the cost of increased risk of cancer and sepsis. Some centers have reported no difference in episodes of ACR per patient and the need for rescue immunosuppressive therapy among older or younger recipients, 16,18 whereas other reports have noted a reduction in ACR in older patients on cyclosporin-based immunosuppression. 16,17 Taken together, these data support the concept of a more tailored immunosuppressive approach to patients aged over 65 yr.…”

Section: Discussionmentioning

confidence: 99%

“…Some centers have reported no difference in episodes of ACR per patient and the need for rescue immunosuppressive therapy among older or younger recipients, 16,18 whereas other reports have noted a reduction in ACR in older patients on cyclosporin-based immunosuppression. 16,17 Taken together, these data support the concept of a more tailored immunosuppressive approach to patients aged over 65 yr.…”

Section: Discussionmentioning

confidence: 99%

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Liver transplantation in patients over 60 and 65 years: An evaluation of long-term outcomes and survival

et al. 2007

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With increased demand for liver transplantation (LT), outcomes of older recipients have been subjected to greater scrutiny, as previous studies have demonstrated poorer survival outcomes. Outcomes of 77 patients aged Ͼ 65 yr (group 1) who underwent transplantation between 1988 and 2003 at King's College Hospital, London, were compared with all recipients aged between 60 and 64 yr (group 2, n ϭ 137) and 202 time-matched control patients with chronic liver disease aged between 18-59 yr (group 3). Patient survival at 30-days for groups 1, 2, and 3 were 99%, 94%, and 94%, respectively (P ϭ not significant [NS]). At 1-yr, survival in the 3 groups was 82%, 86%, and 83%, respectively (P ϭ NS), and at 5-yr patient survival was comparable (73%, 80%, and 78%, respectively) (P ϭ NS). Episodes of acute cellular rejection (ACR) were fewer in the older cohorts (43% vs. 45% vs. 61%, P ϭ 0.0016), although there was no significant difference identified in the numbers of patients in each group who experienced ACR (P ϭ 0.16). A similar but nonsignificant trend was identified for rates of chronic rejection among the groups. In conclusion, these data suggest that survival of patients over 60 and 65 yr undergoing LT is satisfactory, at least in the first 5-yr posttransplantation. In addition, patients over 65 yr experience less rejection, with good graft survival. Thus, LT should not be denied to patients Ͼ65 yr on the basis of age alone, once a comprehensive screen for comorbidity has been undertaken.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Liver transplantation in patients over 60 and 65 years: An evaluation of long-term outcomes and survival

et al. 2007

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“…In a similar recent study, Collins et al compared liver transplantation outcomes in patients over 60 years of age with those in younger adults. 5 The length of hospitalization was the same for both groups, as was the incidence of rejection, infection, repeat operation, and repeat transplantation. There was a difference in long-term survival between the 2 groups, with poorer 5-year survival (52% vs. 75%, P Ͻ .05) and 10-year survival (35% vs. 60%, P Ͻ .05) in the older patients.…”

mentioning

confidence: 99%

Liver transplantation in the elderly: Is caution warranted?

Bhattacharya

Kowdley

2001

Hepatology

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COMMENTSThe average age of liver transplant recipients has steadily increased over recent years. During the early liver transplantation experience, most programs set an upper age limit of 50 to 55 years; however, with improved operative procedures and immunosuppressive therapy, liver transplantation was extended to older recipients. The proportion of liver transplant recipients greater than 60 years of age increased from 10% in 1989 to almost 20% in 1998. 1 Transplantation is now being performed in patients as old as 78 years of age. 2 Concerns over the cost effectiveness of medical care and the equitable allocation of donor organs have caused some individuals to question liver transplantation in the elderly. This subject has been studied by many investigators over the past decade, with the prevailing opinion that elderly recipients of liver allografts fare as well as younger recipients. 3 Despite this, several groups are now reexamining the practice of liver transplantation in elderly patients. One such evaluation was reported by Levy et al., in the article abstracted above.Early studies of liver transplantation in the elderly indicated that postoperative survival was comparable in older and younger recipients. In 1991, Pirsch et al. reported that patient and graft survival were equivalent in older and younger recipients, as was postoperative morbidity. 4 Specifically, they noted a 2-year survival of 83% in recipients age 60 and older, compared with 76% in those age 18 to 59. Critics of this and similar studies, however, suggested that the favorable outcome in elderly patients was because of cautious patient selection, with older patients being accepted for transplantation only if they were excellent candidates in all other respects. 2 In 1998, Zetterman et al. undertook a large study in which agerelated outcomes were measured in liver allograft recipients with similar disease severity. 2 Patients over 60 years of age had lower 1-year survival rates after transplantation (81% vs. 90%, P ϭ .004) and longer hospital and ICU stays than younger patients. The excess mortality in the older patients was due primarily to nonhepatic causes, including infections, cardiac disease, and neurologic complications. Although these outcomes favored the younger patients, quality of life after transplantation was comparable between younger and older recipients, and there was a lower incidence of acute rejection among the older patients. Based on these findings, the authors concluded that transplantation was justified in older patients. In a similar recent study, Collins et al. compared liver transplantation outcomes in patients over 60 years of age with those in younger adults. 5 The length of hospitalization was the same for both groups, as was the incidence of rejection, infection, repeat operation, and repeat transplantation. There was a difference in long-term survival between the 2 groups, with poorer 5-year survival (52% vs. 75%, P Ͻ .05) and 10-year survival (35% vs. 60%, P Ͻ .05) in the older patients. Despite the...

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Outcome of Liver Transplantation in Septuagenarians

Lipshutz¹

2007

Arch Surg

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Hypothesis: We hypothesized that selected septuagenarians may do as well after transplantation as those of a younger group of older recipients. This work compares post-liver transplant survival in septuagenarians with that of patients aged 50 to 59 years. Design: Review of a prospectively maintained database. Setting: University transplant center. Patients: First-time liver transplant recipients treated from January 1, 1988, to December 31, 2005. Group 1 consisted of liver transplant recipients aged 70 years or older at the time of transplant. Group 2 was a younger cohort of patients aged 50 to 59 years. Interventions: Liver transplantation. Main Outcome Measures: Patient survival. Survival data were stratified, Kaplan-Meier survival was calculated, and a multivariate analysis was performed. Results: Group 1 included 62 patients aged 70 years or older (average, 71.9±2.1 years). Group 2 included 864 patients aged 50 to 59 years (average, 54.3±2.9 years). Unadjusted patient survival of group 1 at 1, 3, 5, and 10 years was 73.3%, 65.8%, 47.1%, and 39.7%, respectively. Unadjusted patient survival of group 2 at 1, 3, 5, and 10 years was 79.4%, 71.5%, 65.3%, and 45.2%, respectively. The difference was not statistically significant (P =.14). Multivariate analysis for factors affecting survival demonstrated preoperative hospitalization, cold ischemia time, and hepatitis C/ethanol as risk factors for death. Age 70 years or more was not a strong risk factor (mortality ratio, 1.28; P=.27). Conclusions: When other risk factors for mortality are controlled in older recipients, risk of death due to age is reduced in well-selected recipients. Age by itself should not be used to limit liver transplantation.

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Long-Term Results of Liver Transplantation in Patients 60 Years of Age and Older

Cited by 57 publications

References 12 publications

Liver transplantation in patients over 60 and 65 years: An evaluation of long-term outcomes and survival

Liver transplantation in patients over 60 and 65 years: An evaluation of long-term outcomes and survival

Liver transplantation in the elderly: Is caution warranted?

Outcome of Liver Transplantation in Septuagenarians

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